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ICD-10-CM O01.1, Incomplete and partial hydatidiform mole | No Prior Auth

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`O01.1`, Incomplete and partial hydatidiform mole

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must include the appropriate CPT code, 1 unit of service (UOS), and the appropriate ICD-10-CM diagnosis code.
Additional medical necessity documentation must be submitted when more than 24 markers are tested.
Follow the associated Local Coverage Determination LCD L34215 for full documentation and coverage requirements not detailed here.

Key Coverage Criteria

Flow cytometry is covered for examination of body fluids (including peripheral blood and cerebrospinal fluid), bone marrow, and lymphoreticular tissues (lymph nodes, tonsil, spleen).
Peripheral blood and fine needle aspirate specimens are acceptable for flow cytometry to avoid more invasive diagnostic procedures.
Coverage decisions are governed by the associated Local Coverage Determination LCD L34215 and its specific coverage criteria.

1 Active Policy

A57689, Billing and Coding: Lab: Flow Cytometry

Related Codes

86355(1 policies)86356(1 policies)86357(1 policies)86359(1 policies)86360(1 policies)86361(1 policies)86363(1 policies)86053(1 policies)

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